Individual
RANDALL ALAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPE-I
Contact information
Practice address
110 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 968-1298
(479) 968-6053
Mailing address
2400 S 48TH ST, SPRINGDALE, AR 72762-6683
(479) 750-2020
(479) 750-4843
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
88-12EI
AR
103TC1900X
Counseling Psychologist
Primary
88-12EI
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228376719
—
AR
Enumeration date
12/19/2011
Last updated
04/21/2020
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